Joyce Geoffrey, Ferido Patricia, Thunell Johanna, Tysinger Bryan, Zissimopoulos Julie
University of Southern California (USC) Schaeffer Center for Health Policy and Economics Los Angeles CA Los Angeles County.
USC School of Pharmacy Los Angeles CA Los Angeles County.
Alzheimers Dement (N Y). 2022 Jul 20;8(1):e12309. doi: 10.1002/trc2.12309. eCollection 2022.
Benzodiazepines (BZDs) are commonly prescribed for anxiety and agitations, which are early symptoms of Alzheimer's disease and related dementias (ADRD). It is unclear whether BZDs causally affect ADRD risk or are prescribed in response to early symptoms of dementia.
We replicate prior case-control studies using longitudinal Medicare claims. To mitigate bias from prodromal use, we compare rates of ADRD diagnosis for beneficiaries exposed and unexposed to BZDs for cervical/lumbar pain, stenosis, and sciatica, none of which are associated with dementia.
Approximately 8% of Medicare beneficiaries used a BZD in 2007, increasing to nearly 13% by 2013. Estimates from case-control designs are sensitive to duration of look-back period, health histories, medication use, and exclusion of decedents. Incident BZD use is not associated with an increased risk of dementia in an "uncontaminated" sample of beneficiaries prescribed a BZD for pain (odds ratios (ORs) of 1.007 [95% confidence interval [CI] = 0.885, 1.146] and 0.986 [95% CI = 0.877, 1.108], respectively, in the 2013 and 2013 to 2015 pooled samples). Higher levels of BZD exposure (>365 days over a 2-year period) are associated with increased odds of a dementia diagnosis, but the results are not statistically significant at the 5% or 10% levels (1.190 [95% CI = 0.925, 1.531] and 1.167 [95% CI = 0.919, 1.483]).
We find little evidence of a causal relation between BZD use and dementia risk. Nonetheless, providers should limit the extended use in elderly populations.
苯二氮䓬类药物（BZDs）常用于治疗焦虑和躁动，这些是阿尔茨海默病及相关痴呆症（ADRD）的早期症状。目前尚不清楚BZDs是否会因果性地影响ADRD风险，还是因应痴呆症的早期症状而被处方使用。
我们使用纵向医疗保险理赔数据重复先前的病例对照研究。为减轻前驱期用药带来的偏差，我们比较了因颈椎/腰椎疼痛、狭窄和坐骨神经痛而使用和未使用BZDs的受益人的ADRD诊断率，这些病症均与痴呆症无关。
2007年约8%的医疗保险受益人使用了BZDs，到2013年这一比例增至近13%。病例对照设计的估计结果对回顾期时长、健康史、用药情况以及排除死者等因素敏感。在因疼痛而被处方使用BZDs的“未受污染”受益人群样本中，新使用BZDs与痴呆症风险增加无关（2013年及2013年至2015年合并样本中的优势比（ORs）分别为1.007 [95%置信区间（CI）= 0.885, 1.146]和0.986 [95% CI = 0.877, 1.108]）。更高水平的BZD暴露（两年内超过365天）与痴呆症诊断几率增加相关，但结果在5%或10%水平上无统计学意义（1.190 [95% CI = 0.925, 1.531]和1.167 [95% CI = 0.919, 1.483]）。
我们几乎没有发现BZD使用与痴呆症风险之间存在因果关系的证据。尽管如此，医疗服务提供者应限制在老年人群中的长期使用。
